HomeMy WebLinkAbout1992-12-21 Application for Septic System Permit-EPTIC SYSTEM PERMIT APPLICA TON - PAGE 2
Permit Type i Pees (check one)
New Construction, Full System $100.00 . . . . . . . . . . . . .
Repair or Replace Existing System $50.00. . . . . . . . . . . .
0.50 State surcharge added to above permit fees
SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES
DO NOT MAIL PAYMENT WITH THIS APPLICATION
ZOTE: Applicant must initial all spaces. Fill in all appropriate blanks,
check all appropriate boxes.
Initial
1. I have received a copy of the system design including the
City of Orono Septic System Approval Cover Sheet.
_ 2. I will be installing the following:
A. Tanks: Precast Concrete Other Manufacturer
Tank Capacities: 1) gal. 2) gal. 3) gal.
B. Pump Station (if required)
Pump make & model (attach pump curve &
literature); system design requires vpm at feet
of head. High water alarm make & model
Outside electrical work to be completed by _installer
_electrician other Inside electrical work
must be completed by electrician.
C. Treatment System:
l Trenches: r s.f.
Depth of rock below pipe "
Drub Boxes
Distribution Box
Mound
Rock bed dimensions 'x '
Sand bed dimensions 'x '
Pressure Dist. Pipe Diam. "
Manifold Pipe Diam. "
D. Final Cover/Topsoil to be: borrowed from site
(show location on site plan)
trucked in
The undersigned hereby applies to the City of Orono for issuance of a
septic system installation permit, agrees to do all work in strict
accordance with the ordinances of the City and the regulations of the State
of Minnesota, and certifies that all statements made on this application
ire complete, true and correct.
Signature of Applicant: L.- L�a-u� - Date: /2
4PCA Certification No.: -5 it